Super large bore catheters in the treatment of stroke: systematic review

Background Super large bore aspiration catheters (SLACs; inner diameter ≥0.080 inch) have been introduced to enhance efficacy in mechanical thrombectomy for large vessel occlusion (LVO). Although their use is expanding, clinical data are fragmented across heterogeneous studies. This systematic review aimed to synthesize current evidence on the procedural efficacy and safety of SLACs. Methods A systematic search of PubMed (January 2018–September 2025) was performed in accordance with PRISMA guidelines. Studies were eligible if they included ≥20 patients with LVO treated using an aspiration catheter with an inner diameter ≥0.080 inch as the first line device. Recorded outcomes included first pass effect (FPE), modified Thrombolysis in Cerebral Infarction (mTICI) ≥2c/3, final reperfusion (mTICI ≥2b–3 and mTICI ≥2c–3), symptomatic intracranial hemorrhage, procedural time, and device related complications. Pooled weighted proportions and weighted medians with ranges were calculated. Results Nine studies met the inclusion criteria, encompassing 532 patients treated with six SLAC models. The pooled thrombus access rate was 92.1% (range 82–100%). Mean FPE was 55% (39–73%), and the final successful reperfusion rate (mTICI ≥2c–3) reached 81% (63–94%), including rescue strategies. The median puncture-to-recanalization time was 22 min (IQR 15–37). Among studies reporting functional outcomes (n=6), a favorable outcome (mRS score of 0–2) was achieved in 42% at discharge and in 47.9% at 90 days. Conclusions While SLACs seemed to consistently navigate up to the intracranial occlusion level with low complication rates, the rate of FPE was approximately 55%. Early results are promising, but most data derive from non-randomized or single arm studies. Larger prospective trials are required to define the optimal role of SLACs within contemporary endovascular stroke treatment.